scholarly journals Four-year follow-up of a patient with mixed cardiomyopathy and an implanted cardiac contractility modulation device: a case report

2021 ◽  
Vol 20 (5) ◽  
pp. 2811
Author(s):  
T. M. Uskach ◽  
A. A. Safiullina ◽  
Yu. Sh. Sharapova ◽  
V. A. Amanatova ◽  
A. A. Petrukhina ◽  
...  
Keyword(s):  
Case Report ◽  
Cardiac Contractility ◽  
Severe Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cardiac Contractility Modulation ◽  
Improve Exercise Tolerance ◽  
Optimal Drug

The article presents a case report of a 28-year-old male patient with mixed dilated cardiomyopathy: myocardial noncompaction and chemotherapy-related cardiotoxicity, which led to severe heart failure (HF). With optimal drug therapy, the patient was implanted with a cardiac contractility modulation device in order to improve exercise tolerance, quality of life and relieve HF symptoms. Complex therapy has led to significant clinical and echocardiographic improvement. This case demonstrates a 4-year follow-up of a patient with a reduced left ventricular ejection fraction and an implanted cardiac contractility modulation device, whose condition, after several severe HF decompensations, was stabilized.

scholarly journals Cardiac contractility modulation efficacy: is there a difference between ischemic vs. non-ischemic patients?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Fastner ◽  
I Akin ◽  
G Yuecel ◽  
B Rudic ◽  
I El-Battrawy ◽  
...  
Keyword(s):  
Risk Score ◽  
Nyha Class ◽  
Cardiac Contractility ◽  
Mortality Rates ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Reverse Remodeling ◽  
Cardiac Contractility Modulation ◽  
Over Time

Abstract Background/Introduction Cardiac contractility modulation (CCM) is an FDA approved device therapy for systolic heart failure patients with narrow QRS complex who are symptomatic despite optimal medical therapy. It is used in patients with a wide range of different cardiomyopathies. However, little is known whether the therapy is comparably effective in different entities. Purpose This work investigated the long-term therapeutic effect in patients with ischemic (ICMP) compared to patients with non-ischemic cardiomyopathy (NICMP). Methods 102 patients of our single center registry with known form of cardiomyopathy were included in this retrospective analysis (from 2011–2019). In 68 patients data of a clinical 3-year follow-up were available. The actual mortality rate within one and three years was compared with the one predicted by the MAGGIC risk score and compared between the two groups. In addition, changes in NYHA class, left ventricular ejection fraction (LVEF), LV end-diastolic diameter (LVEDD) and NT-proBNP values were compared as functional parameters. Results Patients with an ICMP (65%) were older (67±1 vs. 57±2 years (SD±SEM); p<0.001) but had a comparable MLHFQ score (42±3 vs. 48±6; p=NS), mean peak VO2 (9.7±1.2 vs. 14.5±2.2 ml/kg/min; p=NS) and QRS width (115±3 vs. 112±4 ms; p=NS). Both groups initially had a comparably advanced limitation during physical activity (median NYHA class III; p=NS); 40% of patients responded with an improvement of at least 1 NYHA class within 3 years (p=NS). The LVEF was 24±1 vs. 22±1% in the beginning and improved to 32±2 vs. 38±2% within 3 years (+33 vs. +73%; p<0.001 in comparison over time; p<0.001 in comparison of the percentage changes ICMP vs. NICMP). While LVEDD was initially significantly wider in NICMP patients (51±2 vs. 67±2 mm; p<0.001), this was offset under therapy, mainly due to a reduction in LVEDD in NICMP patients (+3±2 vs. −7±3 mm; p=0.023). The NT-proBNP values decreased from 4872±776 vs. 5354±1153 to 2051±578 vs. 843±363 ng/l (−58 vs. −84%; p=NS in comparison over time; p=0.093 in comparison of the percentage changes ICMP vs. NICMP). ICMP patients had a higher MAGGIC risk score (27±1 vs. 24±1; p=0.019). Mortality rates at 1 year were 7.4 vs. 17.1% and at 3 years 40.5 vs. 35.5% (each p=NS) compared to mortality rates estimated from the MAGGIC risk score of 21.2 vs. 16.0% (p=0.028) and 44.0 vs. 37.2% (p=0.071), respectively. Chi-square test for comparison of observed and expected frequencies revealed that the number of deaths during 1-year follow-up was significantly lower than predicted only in ICMP patients (p=0.018 compared to the estimated risk). Conclusions NICMP patients had a significantly greater increase in LVEF. Moreover, reverse remodeling with reduction of the LVEDD was only observed in NICMP patients. In summary, significant differences in functional therapy response could be identified between ICMP vs. NICMP patients. Funding Acknowledgement Type of funding source: None

scholarly journals New Generation Cardiac Contractility Modulation Device—Filling the Gap in Heart Failure Treatment

2019 ◽  
Vol 8 (5) ◽  
pp. 588 ◽  
Author(s):  
Diana Tint ◽  
Roxana Florea ◽  
Sorin Micu
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Contractility ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Device Therapy ◽  
Ventricular Ejection Fraction ◽  
Cardiac Contractility Modulation ◽  
New Device ◽  
Wide Range

(1) Background: Heart failure (HF) is a major cause of morbidity and mortality throughout the world. Despite substantial progress in its prevention and treatment, mortality rates remain high. Device therapy for HF mainly includes cardiac resynchronization therapy (CRT) and the use of an implantable cardioverter-defibrillator (ICD). Recently, however, a new device therapy—cardiac contractility modulation (CCM)—became available. (2) Aim: The purpose of this study is to present a first case-series of patients with different clinical patterns of HF with a reduced ejection fraction (HFrEF), supported with the newest generation of CCM devices. (3) Methods and results: Five patients with a left ventricular ejection fraction (LVEF) ≤ 35% and a New York Heart Association (NYHA) class ≥ III were supported with CCM OPTIMIZER® SMART IPGCCMX10 at our clinic. The patients had a median age of 67 ± 8.03 years (47–80) and were all males—four with ischemic etiology dilated cardiomyopathy. In two cases, CCM was added on top of CRT (non-responders), and, in one patient, CCM was delivered during persistent atrial fibrillation (AF). After 6 months of follow-up, the LVEF increased from 25.4 ± 6.8% to 27 ± 9%, and the six-minute walk distance increased from 310 ± 65.1 m to 466 ± 23.6 m. One patient died 47 days after device implantation. (4) Conclusion: CCM therapy provided with the new model OPTIMIZER® SMART IPG CCMX10 is safe, feasible, and applicable to a wide range of patients with HF.

scholarly journals Back to Normal – Normalised Left Ventricular Systolic Function in Dilated Cardiomyopathy after Cardiac Contractility Modulation Therapy

2018 ◽  
Vol 04 (01) ◽  
pp. 25
Author(s):  
Laurens Bon ◽  
Bernhard M Kaess ◽  
Andre Hochgesand ◽  
Albrecht Römer ◽  
Gerd Bürkle ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Systolic Function ◽  
Combined Therapy ◽  
Cardiac Contractility ◽  
Left Ventricular Systolic Function ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cardiac Contractility Modulation

We present a clinical case of a patient with dilated cardiomyopathy who neither sufficiently responded to optimal medical therapy nor to cardiac resynchronisation therapy. A cardiac contractility modulation system was implanted and after ~2 years of combined therapy with medication and devices systolic left ventricular ejection fraction returned to near normal values.

scholarly journals Lymphocytic myocarditis: a genetically predisposed disease?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Artico ◽  
M Merlo ◽  
G Delcaro ◽  
A Cannata ◽  
P Gentile ◽  
...  
Keyword(s):  
Heart Failure ◽  
Genetic Background ◽  
Rna Binding ◽  
Severe Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Lv Dysfunction ◽  
Lymphocytic Myocarditis

Abstract Background Clinical presentation of myocarditis is extremely heterogeneous from asymptomatic to overt severe heart failure (HF). A complex interaction between pre-existing genetic background and inflammation might be responsible for this heterogeneity. Purpose The aim of the present study was to investigate whether positive genetic background for pathogenic cardiomyopathy-related variants might underlie a higher susceptibility to left ventricular dysfunction in patients with active lymphocytic myocarditis. Methods We prospectively performed genetic tests in 36 patients (46±15 years; 61% males; no relatives included) with biopsy-proven active lymphocytic myocarditis according to Dallas criteria and immunohistochemistry. Only pathogenic (P) or likely pathogenic (LP) variants were considered. Results After genetic test, 31% of patients (n=11) were carriers of P/LP truncating variants in structural Cardiomyopathy related genes: Titin (TTN, n=8, 73%), Desmoplakin (DSP, n=1), Filamin C (FLNC, n=1) and RNA binding protein 20 (RBM20, n=1). Among the 27 patients presenting with HF and LV dysfunction, the positive genetic yield was similar to the total cohort (n=9, 34%; 90% with TTN). Two out of six arrhythmic patients (30%) were carriers in arrhythmogenic genes (i.e. DSP and FLNC), whereas no patients with infarct-like presentation were carriers. During follow-up, 44% of patients (n=16) presented normal Left Ventricular Ejection Fraction (LVEF). Carriers had a lower rate of LVEF normalization compared to non-carriers (18% vs 56%, respectively; p=0.035). Conclusion Positive genetic testing for cardiomyopathy-related-genes might be found in a non-negligible percentage of patients with biopsy-proven myocarditis, especially if presenting with heart failure and LV dysfunction. Compared to non-carriers, carriers of P/LP variants show lower likelihood of LVEF normalization during follow-up. Funding Acknowledgement Type of funding source: None

P1491Cardiac contractility modulation in patients with chronic heart failure and atrial fibrillation: 6 months of follow-up

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
O Sapelnikov ◽  
T M Uskach ◽  
D I Cherkashin ◽  
I R Grishin ◽  
D F Ardus ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Nyha Class ◽  
Cardiac Contractility ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Walk Test ◽  
Ventricular Ejection Fraction

Abstract Background Heart failure is developed in 30% of patients with atrial fibrillation (AF). It significantly worsens the prognosis and evaluates the fatal risks for patients. Cardiac Contractility Modulation (CCM) is a new therapeutic device for heart failure, which is used in patients with narrow QRS complexes who are refractory to medical therapy.  Purpose The aim of current study is to demonstrate the effects of CCM on patients with heart failure and AF, influencing on NT-proBNP dynamics and 6 min walk test (6-MWT).  Methods Fourty patients (40) with symptomatic heart failure (II-III NYHA class), persistent/paroxysmal AF and reduced left ventricular ejection fraction (LVEF ≤ 40%) were included. The average age was 60 ± 6 years. MeanLA-volume was 120± 22 ml and NT-proBNP level was 1336 ± 278pg/ml.A 6-MWT was 246 ± 33 m. All patients were implanted with a CCM Optimizer according to the protocol of implantation without an atrial lead. The study compared the mean state changes from baseline to 6 months’ follow-up. Results In 6 months’ follow-up we observed a significant improvement in functional and symptomatic parameters. NT-proBNP level was 1021 ± 153 pg/ml and mean 6 MWT values were 300 ± 26 m. NYHA improved by at least 1 functional class. MeanLA-volume after 6 months of follow-up was 104,5± 18 ml. Conclusions CCM is an effective and safe technology for patients with symptomatic HF. It significantly improves functional parameters, including a 6-minute walk test and NYHA functional class. CCM may prevent HF progression and may influence the outcome.

scholarly journals Cardiac Contractility Modulation in Patients with Heart Failure with Reduced Left Ventricular Ejection Fraction

Hearts ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 156-169
Author(s):  
Francesco Giallauria ◽  
Alessandro Parlato ◽  
Anna Di Lorenzo ◽  
Crescenzo Testa ◽  
Antonio D’Onofrio ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Cardiac Contractility ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cardiac Contractility Modulation ◽  
Innovative Therapy

Cardiac contractility modulation is an innovative therapy conceived for the treatment of heart failure. It is a device-based therapy, employing multiple electrodes to deliver relatively high-voltage (~7.5 V) biphasic signals to the endocardium of the right ventricular septum, in order to improve heart failure symptoms, exercise capacity and quality of life. Multiple clinical and mechanistic studies have been conducted to investigate the potential usefulness of this technology and, as of now, they suggest that it could have a place in therapy and meet a relevant medical need for a specific sub-category of underserved heart failure patients with reduced left ventricular ejection fraction. More studies are needed to further investigate its effect on outcomes such as mortality and rate of hospitalizations.

Peak Oxygen Consumption and Resting Left Ventricular Ejection Fraction Changes After Cardiomyoplasty at 6-Month Follow-up

Circulation ◽  
1995 ◽  
Vol 92 (9) ◽  
pp. 216-222 ◽  
Author(s):  
Edimar Alcides Bocchi ◽  
Guilherme Veiga Guimarães ◽  
Luiz Felipe P. Moreira ◽  
Fernando Bacal ◽  
Alvaro Vilela de Moraes ◽  
...  
Keyword(s):  
Oxygen Consumption ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Peak Oxygen Consumption ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

scholarly journals Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Antonio Leon-Justel ◽  
Jose I. Morgado Garcia-Polavieja ◽  
Ana Isabel Alvarez-Rios ◽  
Francisco Jose Caro Fernandez ◽  
Pedro Agustin Pajaro Merino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Admissions ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Secondary Outcome ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients ◽  
Ed Visits ◽  
The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

Sign in / Sign up

Export Citation Format

Share Document